• Lorenzo Falsetti, Giovanna Viticchi, Nicola Tarquinio, Mauro Silvestrini, William Capeci, Andrea Balloni, Vania Catozzo, Adelina Gentile, and Francesco Pellegrini.
• aInternal and Sub-Intensive Medicine Department, A.O.U. 'Ospedali Riuniti', Ancona, Italy bDepartment of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy cDepartment of Internal Medicine, Ospedale 'S.S. Benvenuti e Rocco', Osimo (Ancona), Italy.
• J Cardiovasc Med (Hagerstown). 2014 Aug 1; 15 (8): 636-41.

BackgroundIn hemodynamically stable patients, mortality and morbidity related to atrial fibrillation are mainly due to cardioembolic disorder. No difference in the survival rate and incidence of embolic events has been described in patients undergoing rhythm or rate control if the latter is combined with an appropriate anticoagulant therapy. CHA2DS2-VASc is a score that allows clinicians to stratify embolic risk in patients affected by nonvalvular atrial fibrillation. Each item can be involved in triggering and maintaining atrial fibrillation. Thus, we hypothesized that CHA2DS2-VASc may help to predict early recurrences after cardioversion.MethodsA total of 319 consecutive patients, admitted to our emergency department or hemodynamically stable persistent atrial fibrillation, were enrolled and treated with electrical or pharmacological sinus rhythm restoration. Outcome was defined as recurrence of atrial fibrillation 5 days after cardioversion. Predicted probability of sinus rhythm stability was assessed with an ordinal regression model using CHA2DS2-VASc as an independent variable.ResultsThe model showed a progressive decrease in the predicted probability of sinus rhythm stability after electrical or pharmacological cardioversion along with an increase in the CHA2DS2-VASc score. A logarithmic relationship was the best-fit trend among CHA2DS2-VASc ranks and the predicted probability of sinus rhythm stability in patients undergoing both electrical and pharmacological cardioversion (r(2) = 0.98, P < 0.05 for electrical cardioversion; r(2) = 0.91, P < 0.05 for pharmacological cardioversion).ConclusionOur preliminary results suggest that CHA2DS2-VASc score could be useful in evaluating the risk of early recurrence of atrial fibrillation after cardioversion. This information may have implications for disease monitoring and treatment strategies in clinical practice.

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